The first reported pulmonary nocardiosis caused by Nocardia gipuzkoensis resisted to TMP-SMZ in an immunocompetent patient

Yishan Duan; Xiaoxia Zhang; Wen Deng; Suyan Wang; Jinrui Hu; Xiaohui Wang; Weimin Li; Bojiang Chen

doi:10.1016/j.jgar.2024.02.008

The first reported pulmonary nocardiosis caused by Nocardia gipuzkoensis resisted to TMP-SMZ in an immunocompetent patient

J Glob Antimicrob Resist. 2024 Mar 8:S2213-7165(24)00031-6. doi: 10.1016/j.jgar.2024.02.008. Online ahead of print.

Authors

Yishan Duan¹, Xiaoxia Zhang², Wen Deng¹, Suyan Wang³, Jinrui Hu¹, Xiaohui Wang⁴, Weimin Li⁵, Bojiang Chen⁶

Affiliations

¹ Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
² Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
³ Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
⁴ Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China; Center for Infectious Diseases, Ya'an People's Hospital, Ya'an, Sichuan Province, China.
⁵ Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China; Precision Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
⁶ Precision Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. Electronic address: cjhcbj@outlook.com.

PMID: 38462073
DOI: 10.1016/j.jgar.2024.02.008

Abstract

Background: . Nocardia gipuzkoensis was first described as a novel and distinct species in 2020 by Imen Nouioui and pulmonary nocardiosis associated with Nocardia gipuzkoensis was once reported in two bronchiectasis patients. Noteworthy, both reported Nocardia gipuzkoensis cases showed sensitivity to Trimethoprim/Sulfamethoxazol (TMP-SMZ), which are usually recommended for empirical therapy.

Methods: We reported the third case of Nocardia gipuzkoensis infection in a 16-year-old girl with chief complaints of cough, persistent chest and back pain. No underlying immuno-suppressive conditions and glucocorticoid use was revealed. Patchy lesions next to spine and located in the posterior basal segment of lower lobes of left lung were seen in thorax computed tomography (CT), but no pathogenic bacteria was detected according to routine laboratory testings.

Results: Metagenomic next-generation sequencing (mNGS) combined with Whole Genome Sequencing (WGS) was used to classified our isolate from bronchoalveolar lavage fluid (BALF) as a Nocardia gipuzkoensis. It is worth mentioning that drug susceptibility testing of our isolate showed resistance to TMP-SMZ, which was never reported before. The patient improved remarkably both clinically and radiographically according to the treatment with Imipenem-cilastatin infusion alone.

Conclusion: mNGS and WGS showed excellent performance in identifying Nocardia genus to the species level and improving detection rate of Nocardia gipuzkoensis ignored by traditional culture. Different from previously reported cases, Nocardia gipuzkoensis infection case showed resistance to TMP-SMZ, which is an unprecedented finding and a crucial addition to our understanding of the antibacterial spectrum of Nocardia gipuzkoensis. The successful treatment with Imipenem-cilastatin infusion alone in this case is a testament to the importance of precise identification and tailored antibiotic therapy.

Keywords: Metagenomic next-generation sequencing (mNGS); Nocardia gipuzkoensis; Trimethoprim/Sulfamethoxazol (TMP-SMZ); Whole Genome Sequencing (WGS); pulmonary nocardiosis.